INTRODUCTION TO

HUMAN NUTRION

Digafe Tsegaye

July 2021
7/30/2021 1
 Session outline
– Nutrition and development.
– Nutritional problems of public Health
Importance in Ethiopia
– Nutrition in Ethiopia: The Way Forward.
– Key Actions to Improve Maternal
Nutrition.
– Key Actions to Improve Child Survival,
Growth, and Development (0-24 months)

7/30/2021 2
 Nutrition and
Development

- Why invest on nutrition? -

7/30/2021 3
Ethiopia was committed to
Millennium Development Goals.

UNICEF/C-55-38/Watson
7/30/2021 4
 Nutrition in the MDGs
MDG
Eradicate extreme poverty
and hunger
Achieve universal primary
education
Promote gender equity and
empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, malaria
and other diseases
Ensure environmental
sustainability
Develop a global partnership
for development
7/30/2021
Relevance of nutrition
Contributes to human capacity and productivity
throughout life cycle and across generations
Improves readiness to learn and school achievement
Empowers women more than men
Reduces child mortality (over half attributable to
malnutrition)
Contributes to maternal health thru many pathways
Addresses gender inequalities in food, care and health
Slows onset and progression of AIDS
Important component of treatment and care
Highlights importance of local crops for diet diversity
and quality
Brings together many sectors around a common
problem
5
 Trends in stunting (low height for age) in children < 5
yrs, by region and year
75

50
% stunted

25

0
1980 1990 1995 2000

SS Africa Asia South America

4th 7/30/2021
Report on World Nutrition Situation, ACC/SCN 6
Rates of stunting in children < 5 years have increased
or remained high in Africa

60

40
%
20

1980 1990 2000

East and Southern West North

7/30/2021 7
De Onis et al, 2000 - WHO Global Databank
 The number of stunted children is rising
dramatically in Africa
Number of children in millions

60

40

20

1980 1990 2000

East and Southern West North Total

7/30/2021 8
De Onis et al, 2000 - WHO Global Databank
 %
G

0
10
20
30
40
50
60
ab
on
N
am
ib
i a
G

7/30/2021
ha
na
B
en
in
K
en
C
am ya
e
M roo
au n
rit
a
T a ni a
nz
an
ia
E
rit
re
a
M
al
N i
B ig
ur re
ki
na i a
Fa
s
U o
M gan
oz
am d a
bi
qu
e
C
ha
R d
w
an
da
E
th
io
pi
Za a
M m
47

ad bi
ag a
years, in selected east African countries

as
ca
M r
Prevalence of stunting in children under five

al
aw
i
9
 Prevalence of stunting in
children in Ethiopia
60 57
52
50 47 45
39 40 41 41 41
40
29 31
30
%
20
18

10

0
z

a
a
s

P
i

i
y
a
r
l

ar

al
ta

fa
um

r
di

a
iy

N
aw
be

ha
m
To

gr
ar

Af
Ad

SN
G

So
am

Am
D

Ti
H

ro
n-
ire

O
G

Be
D

7/30/2021 10
SOURCE: EMDHS2019 11
 The Global conceptual framework for the causes of malnutrition
Reduced educability, lost Functional
productivity, mortality, morbidity consequences

Nutritional Status Manifestation

Immediate
Diet Health Causes

Household Environ. Health, Underlying

Care of Mother
Food Security Hygiene & Sanitation Causes
and Child

Human, Economic, and Institutional

Resources, manmade & natural calamities

Political and Ideological Structure Basic

Ecological Conditions Causes
7/30/2021 12
Potential Resources
Adapted from UNICEF
 Malnutrition: Hidden
Problem

Majority (80%)
mild & moderate

UNICEF/94-1173 Pirozzi
 Victims not aware

7/30/2021 13
Child Malnutrition by Age Group
Percentage
75

50

Stunting
Underweight
25

0
0 12 24 36 48 60

Age (months)

7/30/2021 14
Source:: EDHS 2005
 Nutritional problems of public
Health Importance in Ethiopia

 Protein-energy malnutrition

 Vitamin A deficiency

 Iodine deficiency

 Iron deficiency anemia

7/30/2021 15
 What are the developmental
consequences quantitatively?

Current scientific data

Profiles Model

7/30/2021
Functional Consequences 16
Assumptions & Data Sources
 Period: 2006-2015

 UN Medium Population Projection

 EDHS 2005, National Surveys &

MOH Reports

 Targets: National Micronutrient

Guidelines and National Nutrition
Strategy
7/30/2021 17
 Four Functional Consequences

 Mortality

 Illness

 Intelligence loss

 Reduced productivity

7/30/2021 18
 Malnutrition

•
and
Child Survival

7/30/2021 19
 Causes of Death among
Ethiopian Children 0-5 Years Old
Other 2%
Measles 4%
AIDS 1%
Neonatal 25%
Diarrhea 20%

Malnutrition
53%

Malaria 20%
Pneumonia
7/30/2021 28% 20
 Causes of Child Mortality
in Ethiopia

Malnutrition
53%
Other
47%

• Greatest single cause of child mortality

7/30/2021 21
 Causes of Child Mortality
in Ethiopia

Mild &
moderate

severe

• Only 1 in 5 malnutrition-related deaths

is due to severe malnutrition
7/30/2021 22
Child Mortality (2006-2015)

UNICEF/C-56-19/Murray-Lee
7/30/2021 1.3 million child deaths 23
 Breastfeeding Practices

100

75 Exclusive Complementary
Breastfeeding Feeding
49 50
% 50

UNICEF/93-COU-0173/Lemoyne
25

0
0-6 months 6-9 months
7/30/2021 24
 Infant Deaths due to Poor
Breastfeeding Practices

18%

7/30/2021 25
 Poor Breastfeeding
Practices

50,000
infant deaths

UNICEF/93-COU-0173/Lemoyne
every year
7/30/2021 26
 Breastfeeding and Birth
Spacing
• Total Fertility Rate =
5-6 births per woman

• Delay in fertility due to

breastfeeding = 14
months

• Value of birth spacing

effect of breastfeeding
= 167 million
Birr/year

7/30/2021 UNICEF/D0192-0060/Johnson 27
 Vitamin A Deficiency

 Night blindness

 Ulceration of the cornea

 Permanent blindness

7/30/2021 28
 Children with Vitamin A
Deficiency (VAD)

Permanent blindness

Xerophthalmia

Night blindness

Sub-clinical
Vitamin A deficiency

7/30/2021 29
 VAD: Prevalence

61%

7/30/2021 UNICEF/ Pirozzi 30

 VAD: Associated Mortality

32%

UNICEF/ Pirozzi
7/30/2021 800,000 child lives lost 31
 Low Birth Weight

UNICEF/C-56-19/Murray-Lee
•2006-2015: 0ver 600,000 infant deaths

7/30/2021 32
•
Malnutrition
and
Education

7/30/2021 33
 Malnutrition
and Intellectual Development

Reduced:

 Learning ability

UNICEF/C-56-19/Murray-Lee
 School performance

 Retention rates
7/30/2021 34
Iodine Deficiency: during Pregnancy
 severe mental and physical damage

 moderate mental retardation

 mild intellectual disability

UNICEF/HQ93-2200/Pirozzi
7/30/2021 35
 Iodine Deficiency
and Intellectual Development

100

87
Intelligence Quotient

UNICEF/C-56-19/Murray-Lee
0
Iodine suficient areas Iodine deficient areas
7/30/2021 36
 Total Goiter Rate = 38%

2006-2015:
4.5 million babies
born intellectually
impaired

UNICEF/Ethiopia
7/30/2021 37
 Nutritional Problems Associated
with Brain Development
100

75
Prevalence (%)

50

25 54
38
47

0
13
Goitre
Anemia
Stunting
LBW
7/30/2021 38
 Summary of intellectual
consequences
– Iron deficiency anemia lowers IQ by
• about 9 points

– Mild iodine deficiencies lowers IQ by

• about 10 points

– Severe stunting associated with IQ loss of

• 5-10 points

– Low birth weight babies have IQs

• 5 points lower
7/30/2021 39
 Malnutrition
• and Economic
Development

7/30/2021 40
Economic Consequences of
Malnutrition

Malnutrition results in:

 Mental Impairment

 Physical Stunting
7/30/2021 41
 Iodine Deficiency &
Productivity
– Mental retardation(Cretinism) in fetuses
and children
– Physical shortness(Iodine dewarfism) in
children
– Weakness and morbidity in adults
– Weakness, poor reproduction
– Mortality
– Un-employment and discounting future
earnings
7/30/2021 42
 Productivity Losses
due to Iodine Deficiency (2006-2015)

•Value = 64 billion Birr

UNICEF/93-COU-0931/Ethiopia/Thomas
7/30/2021 43
 Anemia and Productivity
100 Anemia Prevalence

75

54
% 50

27
25

0
Children Women

7/30/2021 (EDHS - 2005) 44

 Anemia
• Iron deficiency anaemia leads to:
– Decreased physical growth in children
and results in short stature

– Impaired learning (Decreased attention

span) in children

– Poor metabolic efficiency and physical

productivity
7/30/2021 45
 Productivity Losses
due to Anemia (2006-2015)

•Value = 36 billion Birr

UNICEF/93-COU-0931/Ethiopia/Thomas
7/30/2021 46
 Child Stunting
• Inadequate
nutrition in
early childhood
1st 24 months
leads to
UNICEF/C-55-34/Watson

reduction of 11
cm in height

7/30/2021 47
 Stunting at Age 2
(EDHS - 2005)

51%
UNICEF/C-55-34/Watson

7/30/2021 48
 Consequence of Stunting

• Reduced
productivity
1.4% decrease in productivity
for every
1% decrease in height
(Haddad & Bouis, 1990)
7/30/2021 49
 Productivity Losses
due to Stunting (2006-2015)
•Value = 44 billion Birr

UNICEF/93-COU-0931/Ethiopia/Thomas
7/30/2021 50
Total Economic Losses with and without
Nutrition Improvement (2005-2015)

Birr (billions) 150

100
Stunting
Anemia
Iodine Deficiency
50

0
No Change Improved

7/30/2021 51
 Total Economic Losses with and without
Nutrition Improvement (2005-2015)

144
150 billion

44
Birr (billions)

100
Stunting
36 Anemia
Iodine Deficiency
50
64

0
No Change Improved

7/30/2021 52
 Total Economic Losses with and without
Nutrition Improvement (2005-2015)

144
150 billion

44 Gain = 46 billion
Birr (billions)

98 billion
100
Stunting
36 37 Anemia
Iodine Deficiency
50 30
64
31
0
No Change Improved

7/30/2021 53
In summary, the functional consequences
of malnutrition are immense:

Deficiency Reduces

Vitamin A survival
PEM Physical
productivity
Iron
IODINE intelligence
7/30/2021 54
 • When is the period of
vulnerability in the life
span of human
development?

7/30/2021 55
 The Intergenerational
Cycle of Malnutrition

Child growth failure

Low birth Early Low weight and

weight babies pregnancy height in teens

Small adult women

7/30/2021 ACC/SCN, 1992 56

 Nutrition

in Ethiopia

- The Way Forward -

7/30/2021 57
 Government Response
• National Micronutrient Guidelines

• National Nutrition Strategy

7/30/2021 58
 Key Actions
to Improve
Maternal Nutrition

7/30/2021 61
 Control of iodine deficiency
disorders

Ensure access to

and consumption

of salt fortified
UNICEF/90-058/Goodsmith

with iodine in

7/30/2021 every household 62

 Control of vitamin A
deficiency

Distribute a

high-dose of

vitamin A within

UNICEF/C-56-19/Murray-Lee
six weeks after

delivery
7/30/2021 63
 Control of iron deficiency
anemia
Distribute

iron supplements

during the last

six months

UNICEF/C-56-19/Murray-Lee
of pregnancy

7/30/2021 64
 Improve access to family
planning services
Delay
first
pregnancy,

Increase

UNICEF/C-56-19/Murray-Lee
birth
intervals

7/30/2021 65
 Increase food intake
Increase food intake

during pregnancy &

lactation:
 Pregnancy (at least 1

additional meal /200kcal)

UNICEF/C-56-19/Murray-Lee
 lactation (at least 2

additional meals/650Kcal)

7/30/2021 66
 Decrease energy
expenditure in the mother

UNICEF/93-COU-0931/Ethiopia/Thomas
Access to labor saving devices
7/30/2021 67
 Care in emergencies

Promote proper caring

UNICEF/90-008/Lemoyne
practices during
emergency situations
including HIV/AIDS

7/30/2021 68
 Integrate food security &
nutrition

Implement food
security activities

LINKAGES Ethiopia
along with
nutritional
interventions

7/30/2021 69
 Key Actions to Improve
Child Survival, Growth, and
Development (0-24 Months)

7/30/2021 70
 Breast Feeding

Promote

exclusive,

on-demand

UNICEF/D0192-0060/Johnson
breastfeeding

until 6 months
7/30/2021 71
 Complementary Feeding
Promote

appropriate

feeding

UNICEF/C-56-19/Murray-Lee
practices

from 6 to 24
7/30/2021
months 72
 Sick Child Feeding

UNICEF/Ethiopia
Promote appropriate child feeding
practices during and after illness.
7/30/2021 73
 Prevention of vitamin A
defciency

Distribute

vitamin A

supplements

UNICEF/HQ91-0031/Eritrea/Sprague
to children

6-59 months
7/30/2021 74
 Improve access to preventive
health interventions
 Immunization

 Malaria control( use bed

nets)

 Safe water

Sanitation
UNICEF/Ethiopia

7/30/2021 75
 Nutrition

in Ethiopia

- Conclusion -

7/30/2021 76
 Compelling Reasons
to Fight Malnutrition
1. The right to food and nutrition
is a human right.
2. Malnutrition deprives children,
women, and communities of
their full potential.
3. Affordable and cost-effective
solutions are available.

7/30/2021 77
 Solutions Need an Alliance
 Government

 Donors

 NGOs

 Communities

7/30/2021 78
 Two Outcomes of this Meeting

1. Consensus on the urgent

need for a National
Nutrition Policy
2. Decentralization to the
regional levels to ensure
mainstreaming into
relevant sectors
7/30/2021 79
 National Nutrition Policy

Benefits
 Child Survival
 Health
 Education
 Agriculture
 Industry

7/30/2021 80
 UNICEFC-92-18/Sprague

7/30/2021
Thank you!

UNICEF/DO192-0009/Ethiopia/Thomas
81